Sen. Chuck Grassley, R-Iowa, ranking member of the Committee on Finance, had harsh words following the issuance of a new report last Friday by the Inspector General for the Department of Health and Human Services, titled Quality Concerns Identified Through Quality Improvement Organization Medical Record Reviews. “These findings are yet another indication that the QIO program needs a major overhaul,” said Grassley, who had requested the analysis last December.
The evaluation examined the role of quality improvement organizations (QIOs) in overseeing and enhancing the quality of care within Medicare by identifying quality-of-care concerns through medical record reviews. According to the report, QIOs selected 318,018 cases for reviews between Feb. 1, 2003, and Jan. 31, 2006. They completed full quality-of-care reviews on 34,768 of these cases, and confirmed one or more quality concerns in 19 percent of them. QIOs assigned the two least serious classifications to more than 80 percent of the cases with a confirmed quality concern, recommended one or more corrective actions in 4,645 cases with a confirmed quality concern, and imposed no corrective actions in 1,794 cases with a confirmed quality concern. In 70 percent of the cases with corrective actions, QIOs recommended the least severe corrective action available. The Inspector General’s report said this raises questions about the effectiveness of the QIO case reviews.
“A major purpose of the QIOs is to review the care provided to Medicare beneficiaries and recommend corrective actions to improve poor quality care,” said Grassley in a statement. “Instead, we’re getting a soft approach that too often accepts poor quality or turns a blind eye. This approach doesn’t get the job done for either taxpayers or Medicare beneficiaries.” Download the report.
